Gee, what could possibly happen in a school where most of the kids don't get the chickenpox vaccine? How about a chickenpox outbreak?

This week that school has been the Asheville Waldorf School, a private school in North Carolina. According to Sam DeGrave, writing for the Asheville Citizen Times, as of last Friday, the highly contagious varicella zoster virus, which causes chickenpox, had already infected at least 36 kids at the school. It is already the state's largest chickenpox outbreak in two decades. And what happened about two decades ago? That was around the time the chickenpox vaccine first hit the U.S. market in 1995. Here's an NBC News report on the outbreak:

Indeed, 110 of the 152 students at the school had not received the chickenpox vaccine, even though it is required by the state board of education. Did all of these students have medical reasons to not get the vaccine? Were all 110 students pregnant, which would have been very unusual for first to eighth graders? Were most of these students chronically taking aspirin, getting blood transfusion, suffering from tuberculosis, or immuno-suppressed? Did they all have life-threatening allergies to the vaccine? No. Instead, as DeGrave wrote, "during the 2017-2018 school year, the last for which data were available, Asheville Waldorf had a higher rate of religious exemptions for vaccination than all but two other schools in the state."

In other words, many parents of students at the school decided that their kids shouldn't get a vaccine that is very effective at preventing the chickenpox. According to the Centers for Disease Control and Prevention (CDC), one dose of the vaccine is 85% effective at preventing any form of varicella (the medical name for chickenpox) and almost 100% effective against severe varicella. Two doses are even better : 88% to 98% effective at preventing any form of varicella and 100% effective against severe varicella.

The CDC recommends that you should get 2 doses of chickenpox vaccine between 12 months and 12 years of age. Your first dose should be in your 12 to 15 months of age window. Your second dose should come in your 4 to 6 years of age of window. If you are older than 12 years old and have still never gotten the vaccine or chickenpox, you can still be vaccinated as long as the 2 doses are separated by at least 28 days. This will give your immune system enough time to react to the first dose before getting a boost from the second dose.

The vaccine also has a very strong safety record. Take a look at the 2008 CDC-FDA reporton patients who received the vaccine from May 1995 through December 2005. As the CDC describes, "the vast majority of people had no or very mild side effects, such as rash and soreness, with the vaccine. Serious side effects linked to the vaccine were extremely rare."

You may think, what's the big deal about getting chickenpox? If you have already had chickenpox, maybe you got away with just having the typical symptoms: 5 to 10 days of fever, loss of appetite, headaches, feeling run down, and the characteristic rashes that go from being pink or red bumps to small blisters to crusty scabs. Maybe you thought that being very itchy and not being able to scratch is not so bad.

But not everyone is so lucky. You can get more severe complications such as pneumonia, encephalitis (which is inflammation of the brain), cerebellar ataxia, bleeding problems, sepsis, and bacterial infections of the skin, soft tissues, bone, and blood. You can even die from the chickenpox. Yes, these complications are rather rare if you are a healthier child. However, if you are an infant or make it to adulthood, not that the two are mutually exclusive, you may be a lot more likely to have more severe disease and complications. If you have a weaker immune system from being very young or older, taking medications, or having a chronic disease, the chances of really bad stuff happening go even higher. And if you are pregnant, start worrying about what the virus may do to your unborn child, such as leading to low-birth weight or birth defects.

This underestimation of chickenpox has led some parents to hold or find "chickenpox parties" to deliberately infect their kids with chickenpox. If you are a kid and everyone is sending you invitations to attend a "pox party," that doesn't necessarily mean that you are cool or popular, especially if you happen to be really itchy. Rather you may just have chickenpox, and they may just be using you for your varicella zoster virus. Talk about a sick party. Here's a news report on these "pox parties":

Then there are parents who mail each other lollipops, clothing, or other items with spit from kids with chickenpox, according to KJ Dell'Antonia writing for Slate. Yes, apparently parents are trying to send highly contagious viruses through the U.S. Mail. Here's one situation where you definitely don't want to accidentally receive someone else's mail. It would be quite a surprise to expect a care package and find a spit-covered sucker instead.

Speaking of suckers, there are also a lot of people out there trying to sell you bogus "alternatives" to vaccines that have no real supporting scientific evidence. These include supplements, herbs, essential oils, homeopathic remedies, chiropractic adjustments, and cabbage. These may be some of the same people trying to spread misinformation about vaccines. So anytime anyone bashes a recommended vaccine that is supported by many scientific studies, check to see what they may be selling as well.

None of these other "options" are as good as the vaccine at preventing chickenpox. Pox parties and disgusting lollipops may not even be succesful in getting your kid infected. After all, a virus, thankfully, may not survive in the mail, and forcing kids to interact closely enough to infect each other is not only a bit weird but can be quite unpredictable.

It is true that chickenpox is usually not as dangerous as the measles, hepatitis B, the flu, or many of the other diseases you should be vaccinated against. However, chickenpox is not exactly a walk in the park and can have serious consequences for you or someone else more vulnerable whom you infect. Chickenpox may be named chicken not because you turn into a chicken but because it seems like the wimpier "relative" of smallpox. But that doesn't mean that you should ever underestimate chickenpox.

I’ve been in the worlds of business, medicine, and global and public health. And these worlds are a lot more similar and different than you think. Currently, I am an Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Executiv...